Who can issue fit notes: guidance for healthcare professionals and their employers

Acknowledgements

The Department of Health and Social Care (DHSC) and the Department for Work and Pensions (DWP) convened an implementation group with representatives from the 4 UK Governments, related skilled our bodies, regulators and statutory training our bodies to supply professional enter and recommendation on implementing reforms to the match observe system.

Health Education England (HEE) was commissioned to work with comparable stakeholders to coordinate the event of UK broad, non-statutory steerage to assist each healthcare professionals (HCPs) and their employers in understanding who’s finest positioned to certify match notes.

It has been developed in session with:

• The Royal College of Occupational Therapists
• The Royal College of Nursing
• The Chartered Society of Physiotherapy
• The Royal Pharmaceutical Society
• The Royal College of General Practitioners
• The General Pharmaceutical Council
• The Nursing and Midwifery Council
• The Health and Care Professions Council
• The British Medical Association
• Scottish Government
• Welsh Government
• Northern Ireland Executive
• Health Education and Improvement Wales
• NHS Education for Scotland
• NHS Employers
• NHS England and Improvement
• Department of Health Northern Ireland
• The Department of Health and Social Care
• The Department for Work and Pensions
• HEE People’s Advisory Forum Representative

Glossary

Term	Expansion
AHPS	Allied Health Professionals [footnote 1]
Allied Health Professional (AHP) Health and Work Report	AHP Health and Work report 2021
DA	Devolved Administration
DHSC	Department of Health and Social Care
Doctor	Registered Medical Practitioner (RMP)
DWP	Department for Work and Pensions
elfh	E-learning for Healthcare
HCPs	Healthcare Professionals. In this steerage, the time period healthcare professionals is used to narrate solely to members of the 5 professions who can certify match notes. These are docs, nurses, occupational therapists, pharmacists and physiotherapists.
HEE	Health Education England
Nurse	Registered nurse
Other HCPs	Is used on this steerage to explain healthcare professionals who are usually not at the moment in a position to certify match notes.
Patient /Person/People and Individual	These phrases are used interchangeably all through the steerage to convey that the wide selection of HCPs now certifying match notes could not all the time use the phrase ‘affected person’ to explain their shoppers/service customers/prospects and so on.

Chapter 1 – Introduction and context

Overview and abstract

1.1 This steerage has been developed to supply recommendation to docs, nurses, occupational therapists, pharmacists, physiotherapists and their employers about certifying match notes. The steerage is designed to supply a abstract of the data, expertise, expertise and coaching these healthcare professionals (HCPs) are anticipated to have earlier than certifying match notes.

1.2 This non-statutory steerage has been developed with professional enter from the 4 UK Governments, related skilled our bodies, affected person representatives, regulators and statutory training our bodies. It contains broad rules relevant throughout all these concerned in certifying match notes, with chapters overlaying:

• Eligible HCPs – the expertise and competence required for people to certify match notes;
• Employer – the duties and duties of these using HCPs enabled to certify match notes; and
• Governance – the related governance issues together with skilled regulation and codes of apply.

1.3 There are a number of cross-cutting points related to each particular person HCPs and employers, as such it is strongly recommended that this steerage is learn in full previous to certifying match notes or making any choices about how this activity is undertaken within the office.

1.4 This steerage sits alongside two different key sources:

1.5 It is essential that people and employers take into account the above sources, alongside this steerage, to grasp: who ought to undertake match observe certification; tips on how to virtually certify a match observe; what match observe certification entails.

Context and Reasons for Change

1.6 It is mostly accepted and there’s proof ^{[footnote 3] [footnote 4] [footnote 5] [footnote 6] [footnote 7] [footnote 8] [footnote 9]} that good high quality work is nice for bodily well being, psychological well being and wellbeing. Evidence additionally signifies that the longer somebody is off work because of sick well being, the much less possible they’re to return to employment^{[footnote 10]}. Even if individuals are not absolutely match, partaking with work can ship well being advantages.

1.7 Modern healthcare displays that HCPs from a variety of disciplines now play a central position in main the supply of healthcare and assist for sufferers to allow them to handle their well being and wellbeing. Increasingly this is applicable to enabling individuals to soundly stay in or return to work wherever attainable, and to handle their very own well being and wellbeing^{[footnote 11]}. Whilst multi-professional working has seen some HCPs with the related expertise and expertise assist work and well being conversations, till July 2022 solely docs (registered medical practitioners) have been legally permitted to certify match notes.

1.8 The Department for Work and Pensions (DWP) amended laws, with impact from 1 July 2022 to allow nurses, occupational therapists, pharmacists and physiotherapists to certify match notes along with docs (these 5 professions are referred to on this steerage as healthcare professionals – HCPs). The laws is permissive, which means that every one these HCPs can legally certify a match observe, however they aren’t required to take action. Individuals ought to take into account their scope of apply and guarantee they’ve the related expertise, data and expertise earlier than enterprise well being and work conversations and making choices round certifying match notes.

1.9 This change got here following public engagement and analysis on the coverage by DWP and Department of Health and Social Care (DHSC) by way of “Improving lives” (inexperienced paper 2016, response revealed 2017)^{[footnote 12]}, “Health is Everyone’s Business” (session 2019, response revealed 2021)^{[footnote 13]} and a broadcast analysis report (2020).^{[footnote 14]}

1.10 There has been broad public assist for extending certification of the match observe which can be mirrored within the views of the stakeholders (para 1.11), who’ve helped form this coverage. Changes have additionally been supported by wider stakeholders who’ve indicated that the match observe shouldn’t be solely accomplished by a health care provider and the system needs to be allowed to embrace new methods of working by involving different HCPs.

1.11 The resolution as to which professions to increase certification to has been agreed following engagement with, and recommendation from: DHSC, Chief Allied Health Profession Officers, Chief Nursing Officers, Chief Pharmaceutical Officers, skilled our bodies, regulators, and coverage officers throughout all 4 nations of the UK.

1.12 Enabling a wider vary of HCPs to certify match notes gives advantages for sufferers and the healthcare system and higher recognises improvements in utilizing a multi-disciplinary workforce to assist sufferers. These HCPs can interact extra straight with sufferers on issues of labor and well being with out having to re-route requests to certify match notes by way of docs.

1.13 The modifications intention to supply a seamless, quicker system for sufferers; enhance continuity of care; scale back paperwork within the healthcare system; and absolutely utilise expertise by enabling related HCPs to conduct well being and work conversations and certify match notes. As a results of the modifications, it’s also anticipated that sufferers and employers will see advantages.

Legislation

1.14 A press release of health for work, generally referred to as a match observe or ‘med 3’, is a type of medical proof that may allow a person to entry health-related advantages or proof eligibility for statutory sick pay (SSP). Its goal, format and necessities are set out in rules which cowl England, Wales and Scotland. The match observe accommodates choices to evaluate an individual as ‘not match for work’ or ‘could also be match for work taking account of the next recommendation’.

1.15 The laws requires the HCP to undertake an evaluation to finish a match observe. An evaluation is outlined as a session between the affected person and HCP or consideration of a written report by one other well being skilled. The match observe supplies recommendation in regards to the practical results of a affected person’s situation on their health for work but it surely doesn’t require the HCP to have specialist data of workplaces or occupational well being or to counsel attainable modifications to a affected person’s office or job.

1.16 Where sufferers are required to proof eligibility for SSP, supplied their employer is content material, they’ll present alternate types of proof^{[footnote 15]}. One instance of that is the ‘AHP Health and Work Report’ ^{[footnote 16]} which will be accomplished by all Allied Health Professions, together with these that aren’t legally in a position to certify match notes.

Legislative change

1.17 In 2017 the DWP confirmed publicly their intention to reform match notes, which on the time may solely be licensed by docs and required a signature in ink to certify them.

1.18 Two legislative amendments have been then made to enhance the match observe and its use.

• Removal of the requirement for signatures in ink (April 2022). This modification eliminated the obstacles to suit notes being accomplished and authorized digitally in order that related methods may very well be up to date to simplify the processes for finishing match notes. (Wet signature match notes proceed to be accepted.)
• Extension of certification of match notes to a wider group of HCPs – nurses, occupational therapists, pharmacists and physiotherapists. This change legally enabled any statutorily registered member of those professions, to certify a legally legitimate match observe.

1.19 The laws ^{[footnote 17]} is permissive, which means that it doesn’t mandate these HCPs to certify match notes. As with any scientific activity, and in step with skilled regulation, particular person HCPs ought to take into account their scope of apply earlier than enterprise well being and work conversations and making choices round certifying match notes.

E-learning for Healthcare coaching (elfh) – ‘The match observe’

1.20 An online training module hosted on elfh has been developed to assist HCPs in getting ready to certify match notes as a part of their apply whether it is an agreed a part of their position. Health Education England (HEE) elfh works in partnership with the NHS {and professional} our bodies to assist affected person care by offering e-learning to teach and practice the well being and social care workforce. Its e-learning programmes are developed in partnership with the NHS, third sector {and professional} our bodies and will be accessed totally free, 24/7 by well being and care professionals.

1.21 The match observe coaching course was developed with HEE and an professional scientific sub-group. It is accessible on the elfh website and accessible to all related HCPs throughout all 4 nations from summer season 2022.

1.22 HCPs beginning to tackle the duty of certifying match notes ought to full the elfh coaching. The targets of the coaching are to assist HCPs:

• to additional develop their confidence and expertise to have an efficient work and well being dialog and to have the ability to perceive and talk (the place acceptable) the significance of labor as a scientific end result;
• to make use of skilled judgement to evaluate influence of a well being situation on a person’s health for work;
• to have the ability to negotiate and develop an agreed plan with the affected person about their well being and work, together with recommendation about self-management and office modifications (the place acceptable);
• to finish the technical steps required within the strategy of finishing a match observe and perceive choices for subsequent steps after a match observe has been licensed e.g., signposting.

1.23 The coaching gives a variety of updated and related info that may assist conversations with professionals who’re new to this activity in clarifying that they’re suitably certified and skilled or enhancing their ability stage to permit them to proceed with confidence. The coaching will allow HCPs to boost and amplify their expertise to have work and well being conversations, knowledgeable by the related coverage and authorized frameworks, thereby serving to people, as acceptable, to hunt work, return to or stay in work.

Chapter 2 – Eligible Healthcare Professionals

2.1 The intention of this chapter is to supply recommendation on the event of additional data, expertise and expertise which is able to assist HCPs to make use of their scientific expertise to undertake well being and work conversations and certify match notes for sufferers.

Certifying match notes

2.2 When first conducting match observe certification, the HCPs who’re legally in a position to certify match notes ought to full the elfh training modules on fit note certification and have a interval of structured mentorship and assist. The interval of mentorship and assist could also be variable in size relying on the event of functionality and confidence, alongside scientific expertise of conversations with the particular person within the care of the skilled about well being and work, together with shared resolution making.

2.3 This put up registration coaching and expertise will assist the event of expertise to make sure the HCP is ready to function with skilled accountability and inside their scope of competence to ship the perfect outcomes for sufferers. See additionally Chapters 1 and 4 on scope of apply and statutory regulation.

2.4 As a minimal, the HCP ought to:

• maintain present registration with the related skilled healthcare regulator;
• have certifying match notes as an agreed a part of their position (if employed or working below a contract);
• have the ability to articulate that certifying match notes is of their particular person scope of apply;
• be concerned with the evaluation, analysis or care planning of the affected person the work and well being dialog pertains to or have the ability to kind an evaluation based mostly on a written report by one other HCP;
• be performing of their skilled capability;
• work in accordance with the necessities of their employer and/or contractual preparations;
• have essential indemnity;
• overview affected person medical information the place acceptable e.g., to evaluate the length of well being situation and certain fluctuation or therapy unintended effects and length.

2.5 Individuals can also want to take into account career particular steerage, the place it has been issued by the related skilled physique.

Relevant expertise for certifying match notes

2.6 The size and kind of expertise that particular person HCPs have on this space will range. Each HCP ought to be certain that they’ve the data, expertise and expertise to undertake this new activity in step with their particular person scope of apply and have the ability to articulate this to their employer if it is an agreed a part of their position.

2.7 HCPs are required to revalidate (renew/re-register) as a situation of their registration. This supplies alternatives to exhibit growth of information, expertise and a reflective account of their apply referring to certifying match notes as acceptable. Employers who want to embrace this new responsibility in current or new job roles might want to take into account any extra related work-based expertise they’ll present to help their HCPs.

2.8 Opportunities to realize related expertise may embrace:

• Observing an skilled HCP conducting well being and work conversations and certifying match notes;
• Case based mostly dialogue with a extra skilled HCP till competent and assured to provide suggestions about well being and work evaluation and intervention, scientific reasoning and resolution making;
• Structured mentorship, assist and supervision from skilled HCPs to efficiently transition their data into apply;
• Opportunities for reflection and suggestions to assist their method;
• Use of each day debrief throughout preliminary interval for security and assurance.
  Ongoing data and expertise growth and dealing in apply

2.9 As a part of ongoing data and expertise growth, HCPs ought to know when to hunt the recommendation of colleagues and mentors a couple of affected person’s well being and work wants. For instance, the related HCP who’s certifying the match observe can, and will the place wanted, make use of the wider experience of their groups to tell well being and work conversations and resolution making close to the match observe.

2.10 As per the laws ^{[footnote 18]}, the HCP certifying the match observe can achieve this based mostly on consideration of a written report by one other well being skilled concerned with the analysis or care planning of the affected person. It isn’t essential for the written report back to be undertaken by a member of one of many 5 professions at the moment listed in rules (para 1.8) as being able to certify match notes. To observe, the HCP who certifies the match observe is accountable, even when based mostly on the written report of one other well being skilled.

2.11 Subject to the required settlement of the affected person, HCPs can also want to share the data {that a} match observe kind has been accomplished with different related skilled colleagues concerned within the affected person’s care. HCPs ought to rigorously take into account with whom they share details about a affected person’s match observe. The healthcare regulators present steerage on affected person confidentiality, together with consent and implied consent, which supplies helpful recommendation on tips on how to decide on the disclosure of knowledge. When deciding profit entitlement DWP could search additional info from professionals concerned within the affected person’s care. Patients give consent for this info to be supplied as a part of their declare and HCPs don’t want to hunt extra consent.

2.12 It is recognised there could also be challenges for HCPs certifying match notes when there’s disagreement about the perfect plan of action and proposals on the match observe. Advice on speaking with sufferers and dealing with tough conversations is roofed within the elfh coaching package deal and in chapter 4. HCPs shouldn’t really feel pressured to signal a match observe.

2.13 HCPs finishing a match observe needs to be considered chargeable for that episode of care, together with responding to any requests for additional info or proof from the DWP or the affected person’s employer all through the match observe.

2.14 HCPs ought to all the time have regard to their skilled accountability/accountability, codes, and requirements in line with the necessities of their respective regulatory physique (see chapter 4).

Chapter 3: Employers of healthcare professionals who could certify match notes

3.1 HCPs which are in a position to certify match notes may fit in all kinds of settings. For these which are employed, it’s suggested {that a} dialog takes place between the person registrant and their employer about whether or not that is an appropriate a part of their employment position when certifying match notes of their employment setting, and the character of this accountability.

3.2 Legislation ^{[footnote 19]} permits match notes to be licensed by sure HCPs (para 1.8). However, it’s in keeping with overarching regulatory rules of excellent healthcare apply and ethics for people and their employers (the place related) that they have to first guarantee they’ve the related expertise, data and expertise to undertake this activity.

E-learning for Healthcare coaching (elfh) – ‘The match observe’

3.3 HCPs new to the duty of certifying match notes ought to full the elfh training (see chapter 1). As a part of this, employers ought to take into account how finest to make sure related HCPs have the required time and area throughout work hours to undertake this coaching and obtain another related assist (see chapter 2 and paragraph 3.7). Employers could discover incorporating this coaching module into inside insurance policies or employment phrases, relying on context.

3.4 All HCPs eligible to certify match notes ought to have entry to the useful resource no matter whether or not or not they’ve an NHS e mail tackle. Once programs are accomplished the platform produces downloadable certificates which can be utilized to permit HCPs to proof their completion of the coaching to their employers, together with when taking over a job with a brand new employer. Additional info relating to the elfh coaching will be present in Chapter 1.

Who ought to certify match notes

3.5 Employers planning their workforce needs to be conscious of balancing the advantages of having the ability to unfold the duty of certifying match notes extra evenly throughout their HCPs with the numerous nature of this accountability.

3.6 A dialog ought to happen with people whose registered career permits them to finish this activity. This ought to embrace each their duties as a registered skilled to work inside their scope of apply (see chapter 2) and the employers’ duties as their employer to supply assist and coaching. This dialog ought to be certain that all particular person HCPs really feel assured that they’re working inside the scope of their competency and scope of apply earlier than asking them to tackle this activity to mitigate in opposition to potential dangers (see chapter 4).

3.7 As a part of this, an employer could want to take into account:

• The HCP’s confidence of their capability to tackle this activity: many HCPs will have already got expertise of supporting sufferers with work and well being conversations and even offering recommendation that informs match notes licensed by docs, whereas others – akin to newly certified HCPs – could have much less prior expertise and really feel they want extra assist earlier than taking this activity on independently, so you will need to focus on with them individually.
• Support inside the employment setting for HCPs taking up this activity: as explored within the elfh coaching module, HCPs could expertise problem from sufferers when having health for work conversations and a few could really feel below strain to certify match notes that don’t replicate their skilled scientific opinion. Consider how formal or casual assist may very well be out there within the office, from inside established supervision practices, to look mentoring from extra skilled colleagues (see record of options at 2.8).
• Clarifying particular person accountability: the HCPs enabled by legislation to certify match notes are anticipated to behave always in accordance with the codes of apply or requirements set out by their regulator {and professional} physique. It is essential to notice that every one such HCPs, if requested to tackle this activity, can be conscious of performing inside their scope of apply (see chapter 4 for extra info) and might want to decide their suitability to answer match observe requests on a person foundation.

Chapter 4: Governance

4.1 The HCPs legally enabled to certify match notes are topic to statutory regulation ^{[footnote 20]}, and subsequently registrants should undertake this activity in a method that’s in keeping with their very own regulator’s requirements, necessities ^{[footnote 21]} and using organisation’s insurance policies and procedures.

4.2 Any eligible registrant beginning to tackle the duty of certifying match notes ought to full the elfh coaching (see chapter 1 and three), in step with regulatory rules referring to sustaining updated data and expertise.

4.3 All the regulatory our bodies ^{[footnote 22]} that oversee the professions enabled by legislation to certify match notes embrace of their requirements of apply a type of phrases stipulating that:

• Registrants should recognise and have the ability to articulate and work inside their particular person competence
• Registrants should maintain their data and expertise updated and related to their scope of apply
• Registrants should undertake persevering with skilled growth

Applying regulatory requirements when certifying match notes

4.4 Beyond the necessity to full acceptable coaching forward of enterprise new duties, all related regulatory our bodies embrace rules which are notably relevant to taking up certifying match notes. Employers and particular person professionals ought to pay explicit consideration to the next rules:

4.5 Competence and scope of apply – The significance of recognising and dealing inside the limits of the HCPs particular person stage of competence, data and expertise, and of looking for enter from appropriately certified colleagues when wanted. This precept is relevant if for instance a affected person requests a match observe because of a well being situation that isn’t inside the scope of a registrant’s scientific apply.

4.6 Person-centred care – The significance of treating individuals as people, upholding their dignity and listening to their issues and preferences, in addition to responding actually to their questions. This precept is especially relevant when having a piece and well being dialog with a affected person which advantages from shared understanding and joint choices about care.

4.7 Teamwork – The significance of working co-operatively with multidisciplinary group colleagues, respecting their expertise and contributions and sharing related data with different colleagues concerned in a affected person’s care. This precept is related as a result of sufferers could have well being and work conversations with a number of members of the scientific group and might profit from clear and constant info.

4.8 Communication – The significance of speaking clearly and professionally with sufferers and the general public, offering the data they want in a method that’s straightforward to grasp and is appropriately recorded. This is especially related provided that written match notes will should be used and understood by not solely the affected person concerned within the health to work dialogue but in addition their employer and others concerned in implementing any recommendation within the observe.

4.9 Confidentiality – The significance of treating all affected person info as confidential and making certain sufferers’ dignity and privateness. This is especially related because of the broad variety of settings by which well being and work conversations could occur and implies that such a dialog shouldn’t happen until a non-public place for dialogue is accessible.

4.10 Raising issues – The significance of elevating issues or difficult poor behaviours when affected person security is in danger, even when tough to take action, and of contributing to a tradition that enables HCPs to lift issues safely. This is especially related as registrants could also be requested to certify match notes in conditions that might imply practising past their position, expertise and competence or below strain from a affected person. They ought to have the ability to confidently refuse to do that and be supported to cope with potential strain to behave exterior {of professional} moral boundaries.

Considerations of employer insurance policies and procedures

4.11 It is essential for HCPs and employers (the place related) to think about sensible points that will have an effect on registrants’ skills to certify match notes in a method that complies with the above regulatory rules.

4.12 For instance, in some settings a HCP could not have entry to a affected person’s related medical historical past and would want to think about whether or not a match observe may very well be appropriately licensed on this circumstance. In different settings a HCP could also be restricted of their capability to attach with different members of the scientific group concerned in a affected person’s care, to the attainable detriment of their capability to make a judgment about health to work.

4.13 As such it’s important that HCPs and people concerned in managing and planning providers take into account these regulatory rules and the particular context they’re working in when making choices about which professionals can appropriately certify match notes to sufferers and repair customers.

Questions for healthcare professionals

1. What is a match observe?

A press release of health for work, generally referred to as a match observe or Med3, is an official assertion from a health care provider, nurse, occupational therapist, pharmacist or physiotherapist. It is issued to supply proof of the recommendation a healthcare skilled (HCP) has given about their affected person’s health for work. HCPs ought to file particulars of the practical results of their affected person’s situation and this doesn’t should be job-specific.

Fit notes can be utilized by each people in work and people out of labor:

• For people in work, the place the recommendation is that they ‘perhaps match for work’, it will probably allow them to return to work with changes. Where changes are usually not attainable, or the place the recommendation is they’re ‘not match for work’, it permits people to realize entry to statutory sick pay.
• For people out of labor it may be used to assist a declare for incapacity-related advantages or to indicate that they’ve been unable to fulfil sure profit necessities.

Fit notes are a great tool to allow higher conversations about work and well being. This will help sufferers: return to work the place acceptable; support their restoration; allow them to speak successfully with their employers about their well being.

2. Who may want a match observe?

If an individual is assessed as having a well being situation that impacts on their capability to work they are often issued with a match observe after the seventh day of sickness. The match observe is a healthcare skilled’s evaluation of a affected person’s health for work. If, following evaluation the affected person is taken into account match for work they don’t want a match observe, even whether it is requested for.

3. Who can certify match notes?

Until July 2022 solely docs have been legally permitted to certify match notes. The Department for Work and Pensions (DWP) amended laws, with impact from the 1 July 2022 to allow nurses, occupational therapists, pharmacists and physiotherapists to certify match notes. These 5 professions are referred to within the steerage as healthcare professionals (HCPs).

Enabling a wider vary of HCPs to certify match notes gives advantages for sufferers and the healthcare system. The modifications intention to supply a seamless, quicker system for sufferers; enhance continuity of care; scale back paperwork within the healthcare system; and absolutely utilise expertise by enabling related HCPs to conduct well being and work conversations and certify match notes.

The HCP certifying the match observe can achieve this based mostly on consideration of a written report by one other well being skilled concerned with the analysis or care planning of the affected person. It isn’t essential for this written report back to be undertaken by a member of one of many 5 professions listed in rules as being able to certify match notes. To observe, the HCP who certifies the match observe is accountable, even when based mostly on the written report of one other well being skilled.

4. Do the modifications apply throughout the entire UK?

Legislative modifications apply to all registered nurses, occupational therapists, pharmacists, and physiotherapists and docs at level of registration in Wales, Scotland, and England.

Northern Ireland are additionally laying their very own laws which is able to mirror this.

5. What coaching and expertise ought to healthcare professionals new to the duty of issuing match notes have?

The HCPs who’re legally in a position to certify match notes ought to full the e-learning for well being coaching modules on match observe certification and have a interval of mentorship and assist when first conducting match observe certification. The interval of mentorship and assist could also be variable in size relying on the event of functionality and confidence, alongside scientific expertise of conversations with the particular person within the care of the skilled about well being and work.

6. Where are you able to entry the e-learning for well being coaching on match notes?

The course is hosted on Programmes – elearning for healthcare and is accessible to all related HCPs throughout all 4 nations from summer season 2022. It is titled ‘The match observe’ and will take two to 4 hours to finish.

7. Will HCPs be utilizing a paper or digital match observe?

Fit notes will be licensed and issued on clerical paper pads or digitally. The format of the match observe will rely upon whether or not the HCP has entry to the related IT methods. Currently solely HCPs working generally apply, with entry to the related IT methods, will have the ability to certify and concern match notes digitally.

The introduction of an embedded digital match observe in GP IT methods adopted the legislative change in April 2022, which eliminated the necessity for handwritten signatures.

Individuals working in secondary care, or with out entry to related GP IT methods, can certify match notes clerically on paper pads, which stay legitimate and have to be ordered directly from DWP.

8. Can HCPs working in a hospital certify a match observe?

Yes, HCPs working in hospitals who’ve accomplished the e-learning and are working inside their scope of apply can and will certify match notes in step with the steerage. If it’s clear on the time of hospital discharge {that a} affected person because of their well being situation will want break day work, a match observe needs to be issued for the total period of time that the affected person can count on to be off work.

9. Can healthcare college students on scientific apply or healthcare assist employees working below delegation certify match notes?

No, solely registered HCPs can certify match notes.

10. Can personal suppliers now certify match notes?

Where personal suppliers are commissioned to ship NHS providers that cowl conditions by which it could be appropriate to certify a match observe, akin to following surgical procedure, they can request clerical match observe pads straight from DWP.

Provided it follows the foundations set out in rules healthcare professionals working privately may concern a report that may be deemed legitimate as a match observe. However, this could solely be carried out whether it is inside their scope of apply as set out within the drafted non-statutory steerage and in step with all scientific duties.
Private suppliers ought to consider the implications of issuing medical proof for health for work that’s provided free to NHS sufferers as there could also be subsequent requests for extra info, notably for DWP advantages, that claimants are usually not anticipated to should pay for.

As entire professions are named in laws, any registered practising physician, nurse, occupational therapist, pharmacist or physiotherapist can legally certify a match observe.

Fit notes are usually not a part of the NHS providers which group pharmacies present and group pharmacists is not going to/do not need entry to the ‘Med3’ – which is the technical title for the match observe supplied totally free below NHS provision.

Fit notes ought to solely be licensed following a full evaluation of a affected person’s health for work, and subsequently needs to be supplied by a clinician with a holistic oversight of the person’s situation.

Pharmacists working in multidisciplinary groups inside normal practices or hospital settings who’re in a position to assess affected person’s health for work, could have entry to the official Med3 kind.

Pharmacists meaning to concern match notes ought to make it possible for they full the suitable coaching and meet the requirements for pharmacy professionals set out by the regulator.

The intention is that ‘the place’ the match observe is licensed will stay the identical however there can be a wider vary of healthcare professionals ‘who’ are in a position to certify the notes.

12. Do I would like entry to a affected person’s medical historical past to certify a match observe?

Individual HCPs might want to assess whether or not they have the required info to make an evaluation and resolution on a affected person’s health to work, this may occasionally embrace accessing a affected person‘s related medical historical past. As with any scientific evaluation HCPs needs to be conscious of the potential implications of enterprise this activity with out entry to medical information. HCPs can also want to discuss with profession-specific recommendation ^{[footnote 23]} and regulatory requirements on this regard as skilled circumstances could differ.

13. Are HCPs issuing match notes in a position to make suggestions to sufferers about work changes?

The match observe needs to be used to provide recommendation in regards to the practical results of a affected person’s situation on their health for work generally. Where HCPs have related coaching or {qualifications} they’ll additionally select to incorporate recommendation on attainable modifications to a affected person’s office or job.

14. What do these modifications this imply for the Allied Health Professionals Health and Work Report? 

It doesn’t change something about this instrument which may nonetheless be used as earlier than, whereby supplied a affected person’s employer agrees it will probably proof eligibility for statutory sick pay (see SSP guidance). The AHP Health and Work Report and the match observe are comparable in content material. HCPs accustomed to the AHP Health and Work report ought to simply transition to certifying match notes.

15. How do HCPs work with their employers to start out utilizing the match observe?

The new steerage is for HCPs and their employers to work out tips on how to make this modification in apply. It covers job roles, scope of apply and the way employers can present in home growth alternatives for HCPs new to the duty of certifying match notes.

As 4 new professions are concerned, employers could discover it simpler to make the modifications throughout impacted employees collectively. For instance, in major care, it is going to be essential to contain Practice Managers, GP’s, Nursing Leads, Nurses, AHP’s and Receptionists within the change.

16. If the modifications are about lowering the burden on GPs, ought to docs delegate requests to certify match notes to nurses, physios, occupational therapists, or pharmacists?

A affected person needs to be assessed by the perfect particular person to handle their well being situation or concern – efficient triage of it will happen at a localised stage in step with different scientific duties. The steerage is evident that the HCP certifying match notes ought to solely achieve this as a part of their agreed scope of apply. It can be price noting that sufferers could not current as particularly requesting a match observe and that, in step with the NHS choice framework, sufferers can request to see particular HCPs.

17. What is the method for affected person complaints about match notes?

In widespread with all affected person complaints, the affected person is ready to elevate a criticism with the organisation offering or commissioning these providers who could have their very own complaints preparations.

18. What additional info can the Department of Work and Pensions request following provision of a match observe?

When deciding profit entitlement DWP could search additional info from professionals concerned within the affected person’s care. This may very well be by way of a phone name or a proper request for a written report. These providers are contracted to healthcare professionals engaged on behalf of DWP (eg from Centre for Health and Disability Assessment).

Patients give consent for this info to be supplied as a part of their declare and you do not want to hunt extra consent. The healthcare regulators present steerage on affected person confidentiality, together with consent and implied consent, which supplies helpful recommendation on tips on how to decide on the disclosure of knowledge, for instance, the General Medical Council confidentiality steerage (paragraph 115) states ‘you could settle for an assurance from an officer of a authorities division or company, or a registered well being skilled performing on their behalf, that the affected person or an individual correctly authorised to behave on their behalf has consented’.

Wherever attainable, info assortment is saved to a minimal however at occasions skilled studies to substantiate claims are wanted. This info is invaluable to make sure your sufferers get their right entitlement with the minimal of disruption.

The type of the data requested will rely upon which profit the claimant is entitled to, for instance most info requests relating to Universal Credit (UC) and Employment and Support Allowance (ESA) claims can be on the UC/ESA113. A full guide to medical evidence reports can be found here. You can full these studies out of your medical information and data of the affected person with out finishing up a separate examination of your affected person.

As outlined within the steerage, the healthcare skilled who licensed the match observe needs to be considered chargeable for that episode of care, together with responding to any requests for additional info or proof from the DWP or the affected person’s employer all through the match observe. To observe, the claimant is chargeable for offering the related contact particulars that DWP use to request additional info.

19. What sources can be found for HCPs to be taught extra about well being and work?

20. Where can I discover the main points of occupational well being suppliers?

Occupational well being assist will be very useful in complicated circumstances and when work could also be affecting your affected person’s well being. Occupational well being providers are generally supplied by NHS or native authority providers. To discover particulars of suppliers in your space, contact: